By Frederick Womakuyu
HELEN Nabulobi, a midwife at Kabeywa Health Centre III in Kapchorwa district, a remote region in the eastern part of Uganda is the unsung heroine of maternal and new-born health.
Not only does she deliver babies, but she also saves lives and promotes good health in society.
In spite of this, more than one in three women in her village gives birth alone or with some relatives to oversee what is considered a very crucial event. This is because she is the only midwife in the area.
â€œI mostly attend to the mothers who come to the health center. I sometimes visit others in the village but I cannot attend to everybody because I am alone, serving a population of 30,000,â€ she says.
Nabulobi, 43, has delivered many babies successfully and also witnessed so many others die. She has been a midwife in Kabeywa since 1988 and the only person to be trained as a midwife in their village since independence. Even then, she rose from a traditional birth attendant to a midwife.
â€œI used to deliver babies locally without any formal training. However, one day, a certain charity came to our village and sponsored me to study midwifery at Mulago Nursing School,â€ adds the mother of eight.
At Mulago, she upgraded her skills and not only delivered her other three children on her own, but helps women at Kabeywa Health Centre III and those who have no access to a health centre nearby to deliver safely.
Since Nabulobi is alone, she cannot reach out to all the women. In fact, she says, about five women in her village die in childbirth annually and that over 84% do not deliver in a health facility.
â€œMany of them live very far from the health facility.
Besides, even if they come to the health facility, we do not have enough manpower to help them all,â€ says Nabulobi, who delivers three every week.
Nabulobi believes that if all women were delivered by a professional, maternal death would be reduced by over 98%.
Severe shortage of midwives
As Uganda joins the rest of the world to launch the first ever State of the Worldâ€™s Midwifery Report with the theme: Delivering Health, Saving Lives, the state of its Midwifery is very poor. The report focuses on 58 countries with high rates of maternal, foetal and new born deaths globally.
According to the UNFPA, globally, approximately 35,000 women experience birth complications every day and about 900 die. In Uganda, over 14 women who experience birth complications die every day. According to Uganda Bureau of Statistics, there is one midwife for every 15,000 Ugandans.
The country has only 7,000 midwives and over 1,961 more midwives are needed at all health facilities nationwide. This gap is wider in rural areas where 1,533 more midwives are needed in all the health facilities compared to the 431 midwives needed in urban government health facilities.
According to the State of Ugandaâ€™s Midwifery Report, 2010, many midwives prefer to work in urban areas citing better pay, job security and freedom in public sector. They also refer to better social services like schools, recreation facilities and accommodation with modern amenities like electricity and internet as their motivation.
Beyond Ugandaâ€™s boarders, there is a current global shortage of over 350,000 professional midwives.
Training more midwives
The report recommends training of more midwives to achieve the health Millennium Development Goals.
In Uganda, the United Nations Population Fund (UNFPA) together with the ministries of health and education will provide scholarships to 80 students of midwifery in areas that face severe shortages. Additional funding will come from the governments of Sweden and the UK. The beneficiaries will work for their districts for at least three years when they complete.
â€œThe next challenge now is to ensure trained midwives are posted, salaried, regularly supervised and retained where they are needed most to save lives of mothers and babies,â€ says Janet Jackson, UNFPA country representative. â€œEveryone is responsible, the Government to provide the vacancies and salaries, the districts to support and appraise health workers and the midwives to be devoted to serving,â€ she says.
The global state of the midwifery report further recommends equipping both public and private-not for profit organisations.
It specifically calls for strengthening partnerships and networks to boost resource mobilisation, advocating for supportive policies, supporting midwifery training and calls on governments to ensure adequate availability and distribution of emergency obstetric and newborn care facilities.
The writer is a journalist